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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_13 | Pages 120 - 120
1 Nov 2021
Gregori P Singh A Harper T Franceschi F Blaber O Horneff JG
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Introduction and Objective

Total shoulder replacement is a common elective procedure offered to patients with end stage arthritis. While most patients experience significant pain relief and improved function within months of surgery, some remain unsatisfied because of residual pain or dissatisfaction with their functional status. Among these patients, when laboratory workup eliminates infection as a possibility, corticosteroid injection (CSI) into the joint space, or on the periprosthetic anatomic structures, is a common procedure used for symptom management. However, the efficacy and safety of this procedure has not been previously reported in shoulder literature.

Materials and Methods

A retrospective chart review identified primary TSA patients who subsequently received a CSI into a replaced shoulder from 2011 – 2018 by multiple surgeons. Patients receiving an injection underwent clinical exam, laboratory analysis to rule out infection, and radiographic evaluation prior to CSI. Demographic variables were recorded, and a patient satisfaction survey assessed the efficacy of the injection.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 348 - 348
1 Jul 2014
Goel S Singh A Mohan K Goel A Gupta K
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Introduction

Very limited treatment options are available for osteoarthritis and most of them are for symptoms of osteoarthritis not for cause. Adult mesenchymal stem cells (MSCs), which have the ability to differentiate into cells of the chondrogenic lineage, have emerged as a candidate cell type with great potential for cell-based articular cartilage repair technologies. We conducted a study to see the effect of direct injection of stem cells on artificially created osteoarthritis model in rabbits.

Methods

Surgical instability was created in 20 adult white rabbits over 16 weeks old and weighing over 2 kg using a modification of the technique of Hulth et al. Only the right knees were operated (with other side serving as control). 12 weeks after surgery, X-rays were done for all 20 rabbits and confirmed for features of osteoarthritis like joint space narrowing, osteophyte formation etc. Bone marrow was aspirated and stem cells were prepared by method of Pittenger et al. Animals were divided into 2 groups of 10 each: Group I (with stem cell infusion) and Group II (control). The radiological evaluation was done at 12 week, 16 weeks, 20 weeks and histological evaluation at 16 and 20 weeks.


Bone & Joint Research
Vol. 3, Issue 2 | Pages 32 - 37
1 Feb 2014
Singh A Goel SC Gupta KK Kumar M Arun GR Patil H Kumaraswamy V Jha S

Introduction

Osteoarthritis (OA) is a progressively debilitating disease that affects mostly cartilage, with associated changes in the bone. The increasing incidence of OA and an ageing population, coupled with insufficient therapeutic choices, has led to focus on the potential of stem cells as a novel strategy for cartilage repair.

Methods

In this study, we used scaffold-free mesenchymal stem cells (MSCs) obtained from bone marrow in an experimental animal model of OA by direct intra-articular injection. MSCs were isolated from 2.8 kg white New Zealand rabbits. There were ten in the study group and ten in the control group. OA was induced by unilateral transection of the anterior cruciate ligament of the knee joint. At 12 weeks post-operatively, a single dose of 1 million cells suspended in 1 ml of medium was delivered to the injured knee by direct intra-articular injection. The control group received 1 ml of medium without cells. The knees were examined at 16 and 20 weeks following surgery. Repair was investigated radiologically, grossly and histologically using haematoxylin and eosin, Safranin-O and toluidine blue staining.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_31 | Pages 9 - 9
1 Aug 2013
Singh A Nicoll D
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Recent projections expect the number of revision knee replacements performed to grow from 38,000 in 2005 to 270,000 by the year 20301. Although the results of primary total knee arthroplasty are well documented, with overall implant survivorship at 15 years greater than 95%2 the results of revision procedures are not as well known. What if the revision TKR fails and what is the prevalence of failure of revision TKRs, the complications and re-operation rates? There are various studies which has either exclusively dealt with the causes or outcomes of revision with a particular prosthesis and survivorship analysis. The effectiveness of revision total knee replacement must be considered in the light of complications rates which could be either medical, orthopaedic surgery related complications or combination of both.

The purpose of this study was to evaluate the prevalence of complications, reoperation rates and outcomes in a single surgeon's series between 1984 and 2008.

Ninety nine index revision cases were studied. Incidences of surgical complications were 52.5%. The total reoperation rate was 34.3% whilst single re revision accounted for 19.9% whereas multiple re-revision incidences were 4%. The mean outcome in terms of Knee Society Score, Knee Society Function, and Knee society range of motion was statistically and clinically significant between pre operative and posts operative score at one year and remained consistent with time. These results suggest that modern revision total knee replacement are satisfactory operations and the outcomes perhaps can be improved if relatively simple strategies are followed by focusing these operations to specialized that accumulate enough experience from these demanding surgeries. Overall the results asserts that even in the hands of an experienced surgeon the complications do occur which is usually multi factorial, whilst in the light of complications and reoperation incidence the patients can be counselled thoroughly before the procedure.


The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 8 | Pages 1143 - 1149
1 Aug 2005
Akmal M Singh A Anand A Kesani A Aslam N Goodship A Bentley G

The purpose of this study was to examine the effects of hyaluronic acid supplementation on chondrocyte metabolism in vitro. The clinical benefits of intra-articular hyaluronic acid injections are thought to occur through improved joint lubrication. Recent findings have shown that exogenous hyaluronic acid is incorporated into articular cartilage where it may have a direct biological effect on chondrocytes through CD44 receptors.

Bovine articular chondrocytes were isolated and seeded into alginate constructs. These were cultured in medium containing hyaluronic acid at varying concentrations. Samples were assayed for biochemical and histological changes.

There was a dose-dependent response to the exposure of hyaluronic acid to bovine articular chondrocytes in vitro. Low concentrations of hyaluronic acid (0.1 mg/mL and 1 mg/mL) significantly increase DNA, sulphated glycosaminoglycan and hydroxyproline synthesis. Immunohistology confirmed the maintenance of cell phenotype with increased matrix deposition of chondroitin-6-sulphate and collagen type II. These findings confirm a stimulatory effect of hyaluronic acid on chondrocyte metabolism.